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NCCN Guidelines Index
Breast Cancer Table of Contents
Discussion
Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines
®
and this illustration may not be reproduced in any form without the express written permission of NCCN
®
.
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
BINV-10
NCCN Guidelines Version 2.2015
Invasive Breast Cancer
Preoperative Systemic Therapy Guideline
a
The panel endorses the College of American Pathologists Protocol for pathology
reporting for all invasive and noninvasive carcinomas of the breast.
http://www.cap.org .b
See Principles of HER2 Testing (BINV-A)
.
c
See NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast and
Ovarian
.
d
See Principles of Dedicated Breast MRI Testing (BINV-B)
.
e
See Fertility and Birth Control (BINV-C)
.
f
Routine systemic staging is not indicated for early breast cancer in the absence of
symptoms.
g
If FDG PET/CT is performed and clearly indicates bone metastasis, on both the PET
and CT component, bone scan or sodium fluoride PET/CT may not be needed.
h
FDG PET/CT can be performed at the same time as diagnostic CT. The use of
PET or PET/CT scanning is not indicated in the staging of clinical stage I, II,
or operable III breast cancer. FDG PET/CT is most helpful in situations where
standard staging studies are equivocal or suspicious, especially in the setting
of locally advanced or metastatic disease.
i
FDG PET/CT may also be helpful in identifying unsuspected regional nodal disease
and/or distant metastases in locally advanced breast cancer when used in addition
to standard staging studies.
dd
In cases where breast-conserving surgery may not be possible but patient will
need chemotherapy, neoadjuvant treatment remains an acceptable option.
CLINICAL STAGE
WORKUP
Stage IIA
T2, N0, M0
Stage IIB
T2, N1, M0
T3, N0, M0
Stage lllA
T3, N1, M0
and
Fulfills criteria for
breast-conserving
surgery except for
tumor size
dd
• History and physical exam
• CBC, platelets
• Liver function tests and alkaline phosphatase
• Diagnostic bilateral mammogram; ultrasound as necessary
• Pathology review
a
• Determination of tumor ER/PR status and HER2 status
b
• Genetic counseling if patient is high risk for hereditary breast cancer
c
• Breast MRI
d
(optional), with special consideration for mammographically occult tumors
• Fertility counseling if premenopausal
e
Consider systemic staging (particularly if signs and symptoms are present):
f
• Chest diagnostic CT
• Abdominal ± pelvic diagnostic CT or MRI
• Bone scan or sodium fluoride PET/CT
g
(category 2B)
• FDG PET/CT
h,i
(optional, category 2B)
See Preoperative
Systemic Therapy
Breast and Axillary
Evaluation (BINV-11)